In order to study the curative effects of L arginine (L Arg) on high altitude pulmonary edema (HAPE),we had treated 10 patients with HAPE by intravenous L Arg at 3700m, and the result was compared with 11 patients who inhaled low concentration nitric oxide (NO) and 24 subjects with routine treatment.The findings were as follows:compared with the routine group, inhaling NO or intravenous L Arg could hasten the disappearance of moist rales and X ray shadow, and shorten the illness time( P 0.05). It suggested that intravenous L Arg is a handy way to treat HAPE, and there is no toxicity. It is worthy of further trial.

To study the effect of oxygen enrichment of room air on the change of hemorheology of soldiers after high altitude hypoxia and exhaustion exercise at 3700 altitude, the oxygen concentration was increased to 24 0%～25 0% in the rooms at 3700m altitude, the change of hemorheology in 10 soldiers after they had 12h rest and sleep in the oxygen enrichment room was examined in no oxygen enrichment resting state and in oxygen enrichment state as well as after exhaustion exercise in no oxygen enrichment room and in oxygen enrichment room.Hematocrit (HCT), blood viscosity (?b), reduction viscosity (?r) and viscometric aggregation index (VAI) were higher after exhaustion exercise in no oxygen enrichment room as compared with those in no oxygen enrichment resting state, the difference was very significant or signifant ( P 0 05),?b, Plasma viscosity (?p), ?r were decreased after exhaustion exercise in no oxygen enrichment room ( P

Retinal neural degeneration diseases is one of the main causes of vision loss , TNF-αas an inflammatory cytokine with pleiotropic biological activity , after binding to its receptor by a variety of signaling pathways , may have play critical role in pathogenesis of retinal neural degeneration diseases including glaucoma , ischemic retinop-athy, age-related macular degeneration and retinitis pigmentosa .

Objective To estimate the clinical efficacy of naloxone and trimetazidine in the treatment of severe viral myocarditis.Methods40 patients with severe viral myocarditis were randomly divided into two groups: control group(20cases) and treatment group(20 cases).All patients in control group and treatment group received conventional therapy.In adition,the patients in treatment group received naloxone and trimetazidine treatment.After 14 days,the changes of clinical symptoms were observed.In addition,serum creatinine kinase(CK)-MB and cardiac troponin I(cTnI) levels were measured.ResultsAlthough the symptoms,CK-MB and cTnI were significantly improved in two groups,but significant difference was still found between control group and treatment group(P

Objective: To investigate changes of the endothelin-1(ET-1) and its receptor (endothelin receptor subtype A, ET AR ) mRNA expression in some organs(kidney, lung and small intestinal mucous membrane) in the sepsis and septic shock rats. Methods: Twenty-four male rats randomized into sepsis group, septic shock group, control and normal group was infused with endotoxin(LPS) via indwelling right atria catheters except normal and control group. RT-PCR was used to detect kidney, lung and small intestinal mucous membrane tissue mRNA expression of the ET-1 , ET AR and glucose-6-phospho dehydrogenase(G-6-PD) in every group.Serum BUN, Cr, ALT and A were determined. The arterial oxygen tension (PaO 2) and arterial carbon dioxide partial pressure(PaCO 2)were measured in every group. Results: ET-1 mRNA and ET AR mRNA expression in the sepsis group and septic shock group were significantly higher than in normal group. There were significant differences between the normal/control group and sepsis/shock group in BUN,Cr,ALT,PaO 2 and PaCO 2. Conclusion: A higher expression of ET-1 mRNA and ET AR mRNA may be one of the startup factors on multiple organ dysfunction syndrome (MODS) and may play an important role on pathogenesis in sepsis and septic shock.

Objective:To investigate the expression of sal-like 4 (SALL4) gene in children with acute leukemia and analyze its clinical significance. Methods:Real-time PCR and immunohistochemistry were used to detect SALL4 mRNA and SALL4 protein ex-pressions in 50 patients initially diagnosed with acute leukemia and in 15 patients with immune thrombocytopenic purpura (ITP), which served as controls. Changes were detected in SALL4 mRNA expression from preliminary diagnosis and after complete remission of 5 acute leukemia patients. The relationship between SALL4 mRNA expression and clinical indicators was analyzed. Results: SALL4 mRNA expression is higher in initially diagnosed B-ALL [13.89 (1.00-63.15)] and AML [11.12 (2.31-56.59)] than in ITP controls [1.00 (0.29-1.71)] (P<0.01). SALL4 mRNA expression in initially diagnosed T-ALL [1.48 (0.87-4.81)] and in controls showed no significant difference (P>0.05). SALL4 protein expression is in agreement with SALL4 mRNA expression. SALL4 mRNA expression significant-ly decreased in complete remission stage [0.98 (0.22-1.09)] than in acute phase [28.64 (11.20-87.46)] in acute-leukemia patients (P<0.01). High SALL4 mRNA expression level is positively correlated with high white blood cell count, high risk classification, and high minimal-residual disease at the end of induction chemotherapy (r=0.424, r=0.40, and r=0.393, respectively;P<0.05), but not with age, gender, hepatomegaly, splenomegaly, and lymphadenectasis (P>0.05). Conclusion:SALL4 was found to play an important role in pro-moting childhood B-ALL and AML, which promises a new target for monitoring the therapeutic effects and evaluating the prognosis of childhood B-ALL and AML.

Giant hypertrophy of gastric mucosa is rare and lack of typical clinical manifestations. The main treatment measures were minimally invasive surgery and drug intervention. Clinicians should pay attention to it's imaging features, in order to make early diagnosis and treatment, and obtain a good prognosis. The authors introduce the results of gastro-enterography and computed tomography in a case with giant hypertrophy of gastric mucosa, and differentiate the imaging results from gastric cancer, lymphoma and gastric stromal tumor, so as to provide references for the clinical diagnosis of the disease.

Objective To study the preventive effect and mechanism of Rhubarb extract on renal injury after cardiopulmonary resuscitation (CPR) in rabbits with cardiac arrest (CA).Methods Twenty-four male Japanese big-ear rabbits were divided into sham operation group, CPR model group and Rhubarb pretreatment group by random number table method, with 8 rabbits in each group. The rabbits in Rhubarb pretreatment group were treated with Rhubarb extract 5 mL·kg-1·d-1 for 7 days; and those in sham operation group and CPR model group were fed with 0.9％ normal saline 10 mL/d for 7 days. After 7 days, ventricular fibrillation (VF) was produced in CPR model group and Rhubarb pretreatment group by 50 V alternating currents stimulation through bottom of the heart leads to the apex to prepare CPR model. The rabbits of the CPR model group and Rhubarb pretreatment group were sacrificed at 2 hours after successful resuscitation, and the animals in the sham operated group were sacrificed directly after anesthesia. The levers of blood urea nitrogen (BUN) and creatinine (Cr) in serum were examined by automatic biochemical analyzer. The positive expression area of neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) in kidney were examined by immunohistochemistry.Results Compared with the sham operation group, the levels of BUN and Cr were significantly increased in the CPR model group and Rhubarb pretreatment group [BUN (mmol/L):15.53±3.90, 10.51±3.16 vs. 7.03±2.23, Cr (μmol/L): 137.20±12.23, 86.80±7.67 vs. 66.39±5.47, bothP < 0.05]. Compared with the CPR model group, the levels of BUN and Cr were significantly decreased in the Rhubarb pretreatment group [BUN (mmol/L): 10.51±3.16 vs. 15.53±3.90, Cr (μmol/L): 86.80±7.67 vs. 137.20±12.23, bothP < 0.05]. Immunohistochemical staining showed that the expression of NGAL and IL-18 mainly existed in glomerular and tubular cells in patina. Compared with the sham operation group, the positive expression areas of NGAL and IL-18 in kidney were significantly increased in the CPR model group and Rhubarb pretreatment group [NGAL (μm2): 208.26±7.58, 136.74±5.33 vs. 98.93±7.83, IL-18 (μm2): 256.48±4.64, 113.22±6.98 vs. 77.06±6.47, allP < 0.05]. Compared with the CPR model group, the positive expression areas of NGAL and IL-18 were significantly decreased in the Rhubarb pretreatment group [NGAL (μm2): 136.74±5.33 vs. 208.26±7.58, IL-18 (μm2): 113.22±6.98 vs. 256.48±4.64,bothP < 0.05].Conclusions CA can lead to acute kidney injury (AKI). Rhubarb extract can reduce the expression of NGAL and IL-18 in kidney of rabbits after CPR, and protect the kidney after CPR.

Objective:To investigate the relationship between antibacterial treatment scheme and prognosis, and to analyze the mortality risk factors of bloodstream infection with carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods:A retrospective case-control study was conducted. The CRKP isolated from clinical venous blood samples in the First Medical Center, Chinese PLA General Hospital between January 1, 2013 and December 31, 2018(not included from January 1, 2016 to December 31, 2017) was collected. According to relevant standards, a total of 50 patients with bloodstream infection with CRKP were included. The patients were divided into death (19 cases) or survival (31 cases) group according to their hospitalization outcomes, and clinical data and antibacterial treatment scheme after infection were collected. The clinical features of the two groups and the correlation between different antibacterial treatment regimens and prognosis were compared. Logistics regression model was used to analyze the risk factors for death in CRKP-infected patients.Results:The all-cause mortality rate of patients with CRKP bloodstream infection during hospitalization was 38%(19/50). The age ((66.89±18.13) vs. (55.06±14.39) years old, t=2.555, P=0.014), charlson's comorbidity index ((6.11±2.87) vs. (3.19±1.97), t=4.256, P<0.001) of the death group was higher than that of the survival group. The proportion of patients with chronic obstructive pulmonary disease (42.1%(8/19) vs. 3.2%(1/31), χ2=9.574, P=0.002), Charlson's comorbidity index ≥5 (68.4%(13/19) vs. 22.6%(7/31), χ2=10.314, P=0.001), septic shock (36.8%(7/19) vs. 6.5%(2/31), χ2=5.456, P=0.020), source of lung infection (36.8%(7/19) vs. 9.7%(3/31), χ2=3.868, P=0.049) was higher in death group than those in survival group. Kaplan-meier survival curve showed that the 30-day mortality of appropriate targeted treatment was lower than that of inappropriate targeted treatment ( χ2=8.138, P=0.004). Multivariate analysis showed that septic shock ( OR=56.363, 95% CI: 4.309-737.273, P=0.002) and charlson's comorbidity index ≥5 ( OR=18.605,95% CI: 1.813-190.896, P=0.014) were independent risk factors for mortality in patients with bloodstream CRKP infection. Conclusion:Appropriate targeted therapy can reduce 30-day mortality in patients with CRKP bloodstream infection. In order to reduce the risk of mortality, we should prevent the occurrence of septic shock and strengthen the diagnosis and treatment of patients with Chalson's comorbidity index ≥5.

Objective: To investigate the clinical value of laparoscopic peritoneal dialysis catheter implantation in peritoneal chemotherapy for gastric cancer with peritoneal metastasis. Methods: From January 2019 to June 2019, the clinical data of 6 patients diagnosed as gastric cancer with peritoneal metastasis were retrospectively analyzed in the Gastrointestinal Surgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Five were male and 1 was female. The median age was 69.5 (28-77) years. The median body mass index (BMI) was 22.8 (19.6-23.5). All procedures were performed under general anesthesia with endotracheal intubation. The patient′s body position and facility layout in the operating room were consistent with those of laparoscopic gastrectomy. The operator′s position: the main surgeon was located on the right side of the patient, the first assistant stood on the left side of the patient, and the scopist stood between the patient′s legs. Surgical procedure: (1) trocar location: three abdominal trocars was adopted, with one 12 mm umbilical port for the 30° laparoscope (point A). Location of the other two trocars was dependent on the procedure of exploration or biopsy as well as the two polyester cuff position of the peritoneal dialysis catheter: Usually one 5 mm port in the anterior midline 5 cm inferior to the umbilicus point was selected as point B to ensure that the distal end of the catheter could reach the Douglas pouch. The other 5 mm port was located in the right lower quadrant lateral to the umbilicus to establish the subcutaneous tunnel tract, and the proximal cuff was situated 2 cm away from the desired exit site (point C).(2) exploration of the abdominal cavity: a 30° laparoscope was inserted from 12 mm trocar below the umbilicus to explore the entire peritoneal cavity. The uterus and adnexa should be explored additionally for women. Once peritoneal metastasis was investigated and identified, primary laparoscopic peritoneal dialysis catheter implantation was performed so as to facilitate subsequent peritoneal chemotherapy. Ascites were collected for cytology in patients with ascites. (3) peritoneal dialysis catheter placement: the peritoneal dialysis catheter was introduced into the abdominal cavity from point A. Under the direct vision of laparoscopy, 2-0 absorbable ligature was reserved at the expected fixation point of the proximal cuff (point B) for the final knot closure. Non-traumatic graspers were used to pull the distal cuff of peritoneal dialysis catheter out of the abdominal cavity through point B. The 5-mm trocar was removed simultaneously, and the distal cuff was fixed between bilateral rectus sheaths at the anterior midline port site preperitoneally. To prevent subsequent ascites and chemotherapy fluid extravasation, the reserved crocheted wire was knotted. From point C the subcutaneous tunnel tract was created before the peritoneal steath towards the port site lateral to the umbilicus. Satisfactory catheter irrigation and outflow were then confirmed. Chemotherapy regimen after peritoneal dialysis catheterization: all patients began intraperitoneal chemotherapy on the second day after surgery. On the 1st and 8th day of each 3-weeks cycle, paclitaxel (20 mg/m²) was administered through peritoneal dialysis catheter, and paclitaxel (50 mg/m²) was injected intravenously. Meanwhile, S-1 was orally administered twice daily at a dose of 80 mg·m^-2·d^-1 for 14 consecutive days followed by 7-days rest. To observe the patients′ intraoperative and postoperative conditions. Results: All the procedures were performed successfully without intraoperative complications or conversion to laparotomy. No 30 day postoperative complications were observed. The median operative time was 33.5 (23-38) min. The median time to first flatus was 1(1-2) days, and the median postoperative hospital stay was 3 (3-4) days, without short-term complications within 30 days postoperatively. The last follow-up was up to July 10, 2019, and the patients were followed for 4(1-6) months. No ascites extravasation was observed and no death occurred in the 6 patients. There was no catheter obstruction or peritoneal fluid extravasation during and after chemotherapy. Conclusion Laparoscopic peritoneal dialysis catheter implantation was safe and feasible for patients with peritoneal metastasis of gastric cancer. The abdominal exploration, tumor staging and the abdominal chemotherapy device implantation can be completed simultaneously, which could simplify the surgical approach, improve the quality of life for patients and further propose a new direction for the development of abdominal chemotherapy.